Provider Demographics
NPI:1053526566
Name:GRIEGO, VICTORIA TRINIDAD (DDS)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:TRINIDAD
Last Name:GRIEGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 W DEER VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2107
Mailing Address - Country:US
Mailing Address - Phone:623-487-4870
Mailing Address - Fax:623-979-8737
Practice Address - Street 1:7505 W DEER VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2107
Practice Address - Country:US
Practice Address - Phone:623-487-4870
Practice Address - Fax:623-979-8737
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ30261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3026OtherSTATE LICENSE